A study aimed at determining the impact of preoperative abdominal aortic aneurysm diameter on the mid-term outcome of endoluminal therapy was conducted by Dutch and British scholars. The results showed that patients with large diameter aneurysms had a higher incidence of aneurysm-related or non-related death and rupture. As of June 2002, 4392 patients with abdominal aortic aneurysms 6 years after receiving endoluminal therapy were included in the study. Patients were divided into 3 groups based on preoperative aneurysm diameter: group A (1,962 patients) had a diameter of 4.0 to 5.4 cm, group B (1,528 patients) had a diameter of 5.5 to 6.4 cm, and group C (902 patients) had a diameter of 6.5 cm or more. The investigators performed a comparative analysis of the general characteristics of the patients, the anatomy of the main iliac artery, the surgical procedures, the different instruments used, and various postoperative complications. Study endpoints included aneurysm-related death, unrelated death, conversion to surgical treatment, and the occurrence of rupture after endoluminal treatment. The results showed that patients in group C had a significantly higher incidence of type I endoleaks in early postoperative arteriography, both in terms of age and operative risk, than in the other two groups (3.7%, 6.8%, and 9.9% in groups A, B, and C, respectively). Postoperative systemic complications were also more common in group C (12.6%, 12.6%, and 17.4% in groups A, B, and C, respectively), and the 30-day morbidity and mortality rate in group C patients was approximately twice that of the sum of groups A and B. Late ruptures were mostly seen in group C patients. Interim follow-up showed that both groups C and B had worse intermediate outcomes than group A. Aneurysm-related mortality was highest in group C, with an annual mortality rate of 1% in the first 3 years, increasing to 8% in the fourth year; non-aneurysm-related mortality was higher in both groups C and B than in group A. The aneurysm-related mortality/unrelated mortality ratios were 23%, 21%, and 50%, respectively. Comment Interventional luminal treatment of abdominal aortic aneurysms is a new therapeutic approach, and follow-up studies with large samples have shown that the long-term complications and mortality rates of this therapy are still high, especially for aneurysms with large aneurysms, whose medium-term results of intracavitary treatment are often accompanied by higher mortality and rupture. This result suggests that there is a need to study and revise the indications for endoluminal intervention, and some cases may still be better treated with conventional surgery in the future.